Original Title: Esfínter urinario artificial versus sling o sustancias abultadoras en incontinencia urinaria severa por vejiga neurogénica, o con falla a otros tratamientos quirúrgicos, en pacientes pediátricos

Authors' recommendations: Very low-quality evidence obtained from non-comparative observational studies does not allow to draw conclusions on the benefit of artificial urinary sphincter (AUS) when compared with the use of sling surgery or bulking agents in urinary incontinence refractory to medical treatment in pediatric patients. Low-quality evidence suggests that the use of artificial urinary sphincter in children with urinary incontinence who have failed surgical treatment might be associated to a significant benefit since it improves continence in cases of severe incontinence, especially when other options such as sling surgery or bulking agents would not be effective. The clinical practice guidelines recommend the use of artificial urinary sphincter in pediatric patients, in cases of severe incontinence, failed conventional treatment and as an alternative to failure with other surgical techniques, considering that, in order to place an AUS, the child should have manual skills to handle it, a bladder with good storage capacity and no urinary tract infections. Aetna, the United States of America private health funder is the only company providing explicit coverage to pediatric patients with incontinence of sphincter etiology, refractory to other treatments and who are not eligible for other types of surgeries. The United States public health funder for the Service Centers of Medicare and Medicaid provides coverage in cases of incontinence due to neurological dysfunction of the urinary sphincter. The health funders from Latin America and high-income countries surveyed do not mention coverage for this technology. No economic studies have been identified in Argentina or the region. When using the AUS in patients with failed surgical treatment or when an associated benefit is not considered, the economic domain of this technology is uncertain.

Project Status: Completed

Year Published: 2024

URL for published report: https://ets.iecs.org.ar/publication/2192

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: <p>Institute for Clinical Effectiveness and Health Policy (IECS)</p>